ABSTRACT
Box 20.1 Assessing fitness to plead and stand trial There are no standardized instruments for assessing fitness to plead: • The first such tool described in a UK setting showed unconvincing reliability and validity (Akinkunmi, 2002). Dependent on a full psychiatric examination, this is a cross-sectional assessment of capacity. Therefore where an advance opinion in writing concludes that the defendant is under disability, this must be followed up by a further assessment and opinion as close as possible to the trial of issue in court. Consider these issues: • Can the defendant explain to you the charges against them in simple terms? • Can they give an account of what factors would lead them to decide on a guilty or not-guilty plea? • Do they have a basic understanding of the people who will be in the court room and their roles? If you
explain an aspect of this to them, can they assimilate it? • Ask them what they would do if they knew someone on the jury, or someone on the jury did not like them. • Can they discuss the events that led to their charges, and give an account of themselves? • How well can they participate during the course of a psychiatric interview? Is there any evidence of
distractedness or distractibility, poor short-term memory, agitation or other impairment? Cognitive deficits: • Simple objective tests of cognitive ability, such as a serial 7s and registering and recalling a name and
address, may be helpful. But they are not determinative, being rather different to the task required in a court room.
